title: Surgical management of sentinel lymph node biopsy outside major nodal basin in patients with cutaneous melanoma.
abstract: OBJECTIVE
  To assess the incidence of nonmajor lymphatic basin sentinel nodes in patients with cutaneous melanoma in order to propose a correct nomenclature and inform appropriate surgical management.
  
  
  METHODS
  This was a retrospective review of 1,045 consecutive patients with cutaneous melanoma who underwent sentinel lymph node biopsy and dynamic lymphoscintigraphy to identify sentinel node site. Nonmajor drainage sites were classified as uncommon (located in a minor lymphatic basin along the lymphatic drainage to a major classical nodal basin) or interval (located anywhere along the lymphatics between the primary tumor site and the nearest lymphatic basin) sentinel nodes.
  
  
  RESULTS
  Nonclassical sentinel nodes were identified in 32 patients (3.0 %). Uncommon sentinel nodes were identified in 3.2 % (n = 17) of trunk melanoma primary disease and in 1.5 % (n = 7) of upper and lower extremity sites. Interval sentinel nodes were identified in 1.3 % (n = 7) of trunk primary lesions, with none from upper and lower extremities melanomas. The incidence of tumor-positive sentinel nodes was 24.1 % (245 of 1,013) in classical sites and 12.5 % (4 of 32) in uncommon/interval sites.
  
  
  CONCLUSIONS
  The definition of uncommon and interval sentinel nodes allows the identification of different lymphatic pathways and inform appropriate surgical treatment. Wider experience with uncommon/interval sentinel nodes will better clarify the clinical implications and surgical management to be adopted in the management of uncommon and interval sentinel node sites.
authors.affiliation: Division of Melanoma, National Cancer Institute, Naples, Italy, corracara@fastwebnet.it.
authors.forename: Corrado
authors.initials: C
authors.lastname: Caracò
authors.forename: Ugo
authors.initials: U
authors.lastname: Marone
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Monta
authors.forename: Luigi
authors.initials: L
authors.lastname: Aloj
authors.forename: Corradina
authors.initials: C
authors.lastname: Caracò
authors.forename: Annamaria
authors.initials: A
authors.lastname: Anniciello
authors.forename: Secondo
authors.initials: S
authors.lastname: Lastoria
authors.forename: Gerardo
authors.initials: G
authors.lastname: Botti
authors.forename: Nicola
authors.initials: N
authors.lastname: Mozzillo
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000096142:Cutaneous Malignant Melanoma